Current Health Care System Research Articles

A qualitative study on the facilitators and barriers to adopting the N-of-1 trial methodology as part of clinical practice: potential versus implementation challenges

ABSTRACT Purpose To investigate opinions among healthcare stakeholders whether implementation of the N-of-1 trial approach in clinical practice is a feasible way to optimize evidence-based treatment results for unique patients. Methods We interviewed clinicians, researchers, and a patient advocate (n = 13) with an interest in or experience with N-of-1 trials on the following topics: experience with N-of-1, measurement, validity and reliability, informally gathered data usability, and influence on physician-patient relationship. Interviews were analysed using qualitative, thematic analysis. Results The N-of-1 approach has the potential to shift the current healthcare system towards embracing personalized medicine. However, its application in clinical practice carries significant challenges in terms of logistics, time investment and acceptability. New skills will be required from patients and healthcare providers, which may alter the patient-physician relationship. The rise of consumer technology enabling self-measurement may leverage the uptake of N-of-1 approaches in clinical practice. Conclusions There is a strong belief that the N-of-1 approach has the potential to play a prominent role in transitioning the current healthcare system towards embracing personalized medicine. However, there are many barriers deeply ingrained in our healthcare system that hamper the uptake of the N-of-1 approach, making it momentarily only interesting for research purposes.

Unveiling the unseen toll: exploring the impact of the Lebanese economic crisis on the health-seeking behaviors in a sample of patients with diabetes and hypertension.

Against the backdrop of Lebanon's escalating multifaceted crisis which resulted in medication shortages for chronic diseases and unaffordable healthcare services, the current study endeavors to shed light on a critical yet overlooked facet of the Lebanese economic crisis- its profound impact on the health-seeking behaviors of patients with hypertension and diabetes mellitus. An exploratory cross-sectional study based on an online questionnaire was conducted on 156 adult Lebanese citizens diagnosed medically with either hypertension or diabetes. We gathered sociodemographic characteristics and healthcare-related challenges faced during the economic crisis. We also assessed stress levels using the Depression Anxiety Stress Scale (DASS-21). Descriptive and bivariate analyses were done using SPSS version 26. The mean age of the population was 49.8 ± 17.7 years old, 51.6% were females and 48.4% were males, 29.7% had diabetes, 51.3% had hypertension and 19.0% had both diseases. Among all, 84.2% reported dissatisfaction with the current healthcare system, 31.6% reported changing their physician mainly because of unaffordable consultation fees (66%) or immigration of the physician (32%). Of those with hypertension and/or diabetes, less than 20% reported finding all their prescribed medications and 47% either modified or discontinued their treatment without seeking medical advice. In case of drug shortage, patients relied on stocked reserves (26%), alternative/generic medications (10%) and external sources for medication procurement such as relatives living abroad (41.7%), outsourcing suppliers (19.9%), dispensaries (19.6%) and NGOs (20.3%). All participants reported a high stress level (5.03/7) with a mean total DASS-21 score of 38.7 ± 35.8 that were attributed to August 4th Beirut port explosion (81.0%), global pandemic (81%), unstable political conditions (90.5%), economic crisis (96.8%), medication shortage (91.8%) and inability to access healthcare (74.1%). Higher sub-scores for anxiety, depression and total stress were insignificantly noted in participants with both hypertension and diabetes (p > 0.05). Our findings explore how the economic crisis has taken its toll on almost all aspects of healthcare in a sample of patients with diabetes and hypertension in Lebanon. The drug shortage as well as disruptions in affordable healthcare access imposed several barriers to adequate adherence to treatment regimens and acted as important mental health stressors.

Hauora Māori – Māori health: a right to equal outcomes in primary care

BackgroundFor more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by “failing to design and administer the current primary health care system to actively address persistent Māori health inequities”. Many Māori (44%) have unmet needs for primary care. Seven models of primary care were identified by the funders and the research team, including Māori-owned practices. We hypothesised patient health outcomes for Māori would differ between models of care.MethodsCross-sectional primary care data were analysed at 30 September 2018. National datasets were linked to general practices at patient level, to measure associations between practice characteristics and patient health outcomes. Primary outcomes: polypharmacy (≥ 55 years), HbA1c testing, child immunisations, ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Regressions include only Māori patients, across all models of care.ResultsA total of 660,752 Māori patients were enrolled in 924 practices with 124,854 in 65 Māori-owned practices.Māori practices had: no significant association with HbA1c testing, ambulatory sensitive hospitalisations or ED attendances, and a significant association with lower polypharmacy (3.7% points) and lower childhood immunisations (13.4% points).Māori practices had higher rates of cervical smear and cardiovascular risk assessment, lower rates of HbA1c tests, and more nurse (46%) and doctor (8%) time (FTE) with patients.The average Māori practice had 52% Māori patients compared to 12% across all practices. Māori practices enrolled a higher percentage of children and young people, five times more patients in high deprivation areas, and patients with more multimorbidity.More Māori patients lived rurally (21.5% vs 15%), with a greater distance to the nearest ED. Māori patients were more likely to be dispensed antibiotics or tramadol.ConclusionsMāori practices are an expression of autonomy in the face of enduring health system failure. Apart from lower immunisation rates, health outcomes were not different from other models of care, despite patients having higher health risk profiles. Across all models, primary care need was unmet for many Māori, despite increased clinical input. Funding must support under-resourced Māori practices and ensure accountability for the health outcomes of Māori patients in all models of general practice.

Interventions to prevent post-tuberculosis sequelae: a systematic review and meta-analysis

Tuberculosis (TB) remains a global public health challenge, causing substantial mortality and morbidity. While TB treatment has made significant progress, it often leaves survivors with post-TB sequelae, resulting in long-term health issues. Current healthcare systems and guidelines lack comprehensive strategies to address post-TB sequelae, primarily due to insufficient evidence. This systematic review and meta-analysis aimed to identify effective interventions for preventing post-TB sequelae. A systematic search was conducted across four databases including PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials from inception to September 22, 2023. Eligible studies reported interventions designed to prevent post-TB sequelae were included. A random effect meta-analysis was conducted where applicable, and heterogeneity between studies was evaluated visually using forest plots and quantitatively using an index of heterogeneity (I2). This study is registered with PROSPERO (CRD42023464392). From the 2525 unique records screened, 25 studies involving 10,592 participants were included. Different interventions were evaluated for different outcomes. However, only a few interventions were effective in preventing post-TB sequelae. Rehabilitation programs significantly improved lung function (Hedges's g=0.21; 95% confidence interval (CI): 0.03, 0.39) and prevented neurological sequelae (relative risk (RR)=0.10; 95% CI: 0.02, 0.42). Comprehensive interventions and cognitive-behavioural therapy significantly reduced the risk of mental health disorders among TB survivors (Hedges's g=-1.89; 95% CI:-3.77,-0.01). In contrast, interventions targeting post-TB liver sequelae, such as vitamin A and vitamin D supplementation and hepatoprotective agents, did not show significant reductions in sequelae (RR=0.90; 95% CI: 0.52, 1.57). Moreover, adjunctive therapies did not show a significant effect in preventing post-TB neurological sequelae (RR=0.62, 95% CI: 0.31, 1.24). Rehabilitation programs prevented post-TB lung, neurologic and mental health sequelae, while adjuvant therapies and other interventions require further investigation. Healy Medical Research Raine Foundation, Curtin School of Population Health and the Australian National Health and Medical Research Council.

A Framework for Implementing Disease Prevention and Behavior Change Evidence at Scale.

The current corpus of evidence-based information for chronic disease prevention and treatment is vast and growing rapidly. Behavior change theories are increasingly more powerful but difficult to operationalize in the current healthcare system. Millions of Canadians are unable to access personalized preventive and behavior change care because our in-person model of care is running at full capacity and is not set up for mass education and behavior change programs. We propose a framework to utilize data from electronic medical records to identify patients at risk of developing chronic disease and reach out to them using digital health tools that are overseen by the primary care team. The framework leverages emerging technologies such as artificial intelligence, digital health tools, and patient-generated data to deliver evidence-based knowledge and behavior change to patients across Canada at scale. The framework is flexible to enable new technologies to be added without overwhelming providers, patients or implementers.

Opioids and Youth Athletes.

The ongoing opioid epidemic and associated adverse effects impart a large burden on our current healthcare system. The annual economic and noneconomic cost of opioid use disorder and fatal opioid overdose is currently estimated at $1 trillion. This review presents the prevalence, frequency of use, need, and effectiveness of opioid analgesia in the youth and adolescent athlete population. It identifies current indications for opioid versus nonopioid analgesic use in the setting of acute orthopaedic injuries, postoperative management, concussion, and chronic pain. Current knowledge of youth athlete opioid use, risks related to use, misuse, diversion, and addiction are reviewed. A PubMed, Medline, and Cochrane Library search was conducted in February 2023 to review opioid pain management strategies in the pediatric athlete population from 2000 to present. Searches were restricted to English language articles and human subjects. Initial reviews of titles and abstracts were performed by all authors and relevant full-text articles were selected. Priority was given to systematic and narrative reviews, meta-analyses, and prospective studies. Narrative review. Level 3. First author name, publication year, study design, study country, subject demographics, and data on the frequency, type, and duration of analgesic treatments for musculoskeletal injuries, postsurgical care, chronic pain disorders, and concussion were extracted. Pediatric athletes comprise a high-risk population seeking analgesic relief for injury-related pain. Participation in high school sports is associated with increased risk of opioid use. An average of 28% to 46% of high school athletes have used opioids in their lifetime. Participation in ≥1 high school sport puts adolescents at 30% greater odds of future opioid misuse. The use of opioids in the pediatric athlete population is common and associated with both short- and long-term risks of misuse and addiction.

Organic food and its health benefits for humans and how it differs from regular food : Review.

As public awareness of organic food products' advantages for health, social convenience, the environment, and sustainable development has grown, so has their knowledge of their benefits. Gaining understanding of consumer views is crucial for the sector as it continues to grow. The current study was methodically created to assess the strength of the data supporting the benefits of feeding organic foods to health. Foods labeled as organic are produced utilizing only natural fertilizers. The regulations around organic animal production are extensive and impact various aspects such as nutrition, reproduction, housing, medical care, and treatment. Additionally, these foods are not produced using genetically modified pesticides or insecticides. Animals raised in organic farms are given more space to live in than those raised in conventional systems, and they are also required to consume organic feed, straw bedding, and roughage. The fatty acid composition of milk, eggs, and meat is significantly influenced by the animal diet. Breed selection is used in connection to animal health and wellbeing; proper diet, husbandry, and management all contribute to illness prevention and improved animal welfare. Antimicrobial durability is a global public health concern these days, and many international health organizations recognize that it poses a threat to the current health care system. Thus, the market's demand for organic products and their simplicity of use has grown over the past several years, contributing significantly to the economy. Because organic food is healthier and less likely to contain chemicals, many people are beginning to choose it over conventional food. As a result, raising consumer knowledge of the value of organic products and supporting their production is crucial for the growth of organic farming and the production of pure water. The market for organic food products is growing quickly because consumers believe that organic food may be healthier than conventional food and has a superior nutritional profile.

A Game-Theoretic Analysis of the Adoption of Patient-Generated Health Data

Patient-generated health data (PGHD) have great potential to improve clinical outcomes. As providers consider whether and how to incorporate PGHD into their clinical workflows, platforms by Apple and Amazon stand to fundamentally alter the landscape. With the aim to examine the conditions under which providers would adopt PGHD and possibly sign on with a platform, we analyzed the incentives and optimal strategies of two healthcare providers, a monopoly platform, and consumers using stylized game-theoretic models and solve for potential equilibria. We found that consumer surplus always increased with PGHD adoption, but social welfare may drop. The larger provider had more incentive to adopt PGHD than the smaller provider, but these incentives were reversed in the case of platform adoption. Accordingly, the platform enrolled the smaller provider first and possibly both providers. The emergence of the platform raised provider surplus, potentially at the expense of the consumers, despite offering its service to them for free. These results illustrate the importance of economic incentives regarding whether and how PGHD could be incorporated into our current healthcare system.

The Coproduction of Health Framework: Seeking Instructive Management Models and Theories.

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

Light-M: An efficient lightweight medical image segmentation framework for resource-constrained IoMT

The Internet of Medical Things (IoMT) is being incorporated into current healthcare systems. This technology intends to connect patients, IoMT devices, and hospitals over mobile networks, allowing for more secure, quick, and convenient health monitoring and intelligent healthcare services. However, existing intelligent healthcare applications typically rely on large-scale AI models, and standard IoMT devices have significant resource constraints. To alleviate this paradox, in this paper, we propose a Knowledge Distillation (KD)-based IoMT end-edge-cloud orchestrated architecture for medical image segmentation tasks, called Light-M, aiming to deploy a lightweight medical model in resource-constrained IoMT devices. Specifically, Light-M trains a large teacher model in the cloud server and employs computation in local nodes through imitation of the performance of the teacher model using knowledge distillation. Light-M contains two KD strategies: (1) active exploration and passive transfer (AEPT) and (2) self-attention-based inter-class feature variation (AIFV) distillation for the medical image segmentation task. The AEPT encourages the student model to learn undiscovered knowledge/features of the teacher model without additional feature layers, aiming to explore new features and outperform the teacher. To improve the distinguishability of the student for different classes, the student learns the self-attention-based feature variation (AIFV) between classes. Since the proposed AEPT and AIFV only appear in the training process, our framework does not involve any additional computation burden for a student model during the segmentation task deployment. Extensive experiments on cardiac images and public real-scene datasets demonstrate that our approach improves student model learning representations and outperforms state-of-the-art methods by combining two knowledge distillation strategies. Moreover, when deployed on the IoT device, the distilled student model takes only 29.6 ms for one sample at the inference step.

Exploring challenges to the uptake of sexual and reproductive health services among lesbian and bisexual women in Bulawayo, Zimbabwe: a qualitative enquiry.

Reproductive healthcare is essential for all people, including lesbian and bisexual women. However, lesbians and bisexual women are among society's most marginalised and excluded members. This study aimed to explore the challenges faced by lesbian and bisexual women in accessing Sexual and Reproductive Health (SRH) Services in Bulawayo, Zimbabwe. An exploratory, descriptive qualitative study was conducted on two populations that included eight participants identified through the Voice of the Voiceless organisation in Bulawayo and 10 key informants and probed the challenges faced by lesbians and bisexual women when accessing SRH services. Data were gathered through 10 key informant interviews and 1 focus group discussion (FGD; with 8 participants). The interviews and FGDs were recorded, transcribed verbatim, coded and thematically analysed. The themes that emerged included the uptake of SRH services among lesbians and bisexual women, the challenges faced by lesbians and bisexual women when accessing SRH services, and strategies to aid the uptake of SRH services by lesbians and bisexual women. The findings showed that the uptake of SRH services was generally low and was influenced by factors such as clinical settings. The challenges mentioned included stigma and the unavailability of specific lesbian and bisexual women's services. By contrast, the most frequent strategies included affirmative training for healthcare providers and improved clinical settings to become friendly and inclusive. There is an imperative for targeted SRH services that address the distinct needs of lesbians and bisexual women, in line with the 95-95-95 strategy and Sustainable Development Goals target 3.7. The observed low uptake of these services can be attributed to several systemic barriers, including inadequate training of health providers, negative attitudes and lack of inclusive policies. Enhancing the sensitivity of health facilities, strengthening links to sexual health education and implementing supportive legal frameworks are essential steps to improve SRH outcomes in this population. These findings elucidate critical gaps within the current healthcare system and present significant opportunities for policymakers to formulate evidence-based strategies to ensure equitable access to SRH services, thereby advancing public health objectives.

My One Wild and Precious Life—The Purpose of Medical Care

“My One Wild and Precious Life - The Purpose of Medical Care”, contains reflections of a medical student as a naive little boy, inspired by his late grandfather, pinning to becoming a physician, who later struggles to find purpose in the unidealistic world of the current healthcare system. But, through his exposure to “Pallium India”, a non-profit palliative care organization in Kerala, India, healthcare once more gains meaning and signifies the importance of love and care amidst a patient's journey through pain and suffering.

Making Digital Health Equitable.

Most agree that the current healthcare system is broken. Fortunately, technology is increasing at an exponential rate and provides a solution for the future. Digital Health is an integrator concept that has the potential to take advantage of technological advantages. Digital Health converges health, healthcare, research, and everyday life. It includes technologies, platforms, and systems that engage consumers in all aspects of life. It makes health and healthcare be people-centered and personalized. Digital health requires total interoperability - standards, common data elements, and the integration of data from all sources. It demands data sharing. Digital Health brings together a wide range of stakeholders for similar goals using the same resources. Digital Health uses mobile devices and wearable sensors and uses Artificial Intelligence and Machine Learning to handle the vast amount of data Digital Health engages. Finally, Digital Health has the potential to open the gap between the different social and economic classes that must be addressed.

Integration of traditional, complementary, and alternative medicine with modern biomedicine: the scientization, evidence, and challenges for integration of traditional Chinese medicine

Traditional medicine has garnered significant global recognition, with an estimated 80% of the global population using it. Therefore, it is essential to fully understand the integration of traditional medicines into current healthcare systems. This review aims to provide a comprehensive overview of the standard process to modernize traditional medicine scientifically in the context of modern biomedicine, further termed here as “scientization”. Specifically, we aim to summarize the advancements made in understanding the efficacy, effectiveness, and underlying mechanisms of herbal medicine. We also examined the transition from experience- to evidence-based medicine during acupuncture. Furthermore, we explore the development of universal safety and quality control standards. Finally, we discuss international trade and export markets for Chinese medical products. The development and integration of traditional medicine have allowed it to further improve human health, resulting in a more comprehensive health solution for the global population.

Trust in and Acceptance of Artificial Intelligence Applications in Medicine: Mixed Methods Study.

Artificial intelligence (AI)-powered technologies are being increasingly used in almost all fields, including medicine. However, to successfully implement medical AI applications, ensuring trust and acceptance toward such technologies is crucial for their successful spread and timely adoption worldwide. Although AI applications in medicine provide advantages to the current health care system, there are also various associated challenges regarding, for instance, data privacy, accountability, and equity and fairness, which could hinder medical AI application implementation. The aim of this study was to identify factors related to trust in and acceptance of novel AI-powered medical technologies and to assess the relevance of those factors among relevant stakeholders. This study used a mixed methods design. First, a rapid review of the existing literature was conducted, aiming to identify various factors related to trust in and acceptance of novel AI applications in medicine. Next, an electronic survey including the rapid review-derived factors was disseminated among key stakeholder groups. Participants (N=22) were asked to assess on a 5-point Likert scale (1=irrelevant to 5=relevant) to what extent they thought the various factors (N=19) were relevant to trust in and acceptance of novel AI applications in medicine. The rapid review (N=32 papers) yielded 110 factors related to trust and 77 factors related to acceptance toward AI technology in medicine. Closely related factors were assigned to 1 of the 19 overarching umbrella factors, which were further grouped into 4 categories: human-related (ie, the type of institution AI professionals originate from), technology-related (ie, the explainability and transparency of AI application processes and outcomes), ethical and legal (ie, data use transparency), and additional factors (ie, AI applications being environment friendly). The categorized 19 umbrella factors were presented as survey statements, which were evaluated by relevant stakeholders. Survey participants (N=22) represented researchers (n=18, 82%), technology providers (n=5, 23%), hospital staff (n=3, 14%), and policy makers (n=3, 14%). Of the 19 factors, 16 (84%) human-related, technology-related, ethical and legal, and additional factors were considered to be of high relevance to trust in and acceptance of novel AI applications in medicine. The patient's gender, age, and education level were found to be of low relevance (3/19, 16%). The results of this study could help the implementers of medical AI applications to understand what drives trust and acceptance toward AI-powered technologies among key stakeholders in medicine. Consequently, this would allow the implementers to identify strategies that facilitate trust in and acceptance of medical AI applications among key stakeholders and potential users.

Digitalization of Family Planning Services: A Reality or Fantasy?

This position paper examines the changing environment of digitalizing family planning services, investigating how established healthcare paradigms might be transformed via the incorporation of new technology. The increasing use of digital technologies in the healthcare sector has brought attention to the provision of family planning services, leading to an examination of the practicality and achievability of this technological advancement. The study explores several aspects of this discussion, such as the present condition of family planning services, technical advancements, obstacles to digitalization, user viewpoints, and policy deliberations. The story begins by analysing the wider digitalization patterns in healthcare, setting the stage for the convergence of technology and reproductive health. The study critically examines the significance of digital technologies in family planning, including both the potential advantages and difficulties they may provide. It tackles the obstacles related to privacy, access, and cultural factors, in contrast to the optimistic potential of developing technology. The article showcases case studies and success stories that demonstrate the effectiveness of digital family planning, offering significant insights for future implementation. The report finishes by endorsing a series of policy proposals designed to navigate the complex interaction between technology, ethics, and healthcare infrastructure. These proposals prioritise the need of explicit rules, purposeful investments in digital literacy and accessibility, and smooth integration into current healthcare systems. This study examines the digitization of family planning services, highlighting its role as both a technical innovation and a potential driver of social change. It emphasises the importance of individual empowerment and well-being in discussions about reproductive health.

Predicting an Optimal Medication/Prescription Regimen for Patient Discordant Chronic Comorbidities Using Multi-Output Models

This paper focuses on addressing the complex healthcare needs of patients struggling with discordant chronic comorbidities (DCCs). Managing these patients within the current healthcare system often proves to be a challenging process, characterized by evolving treatment needs necessitating multiple medical appointments and coordination among different clinical specialists. This makes it difficult for both patients and healthcare providers to set and prioritize medications and understand potential drug interactions. The primary motivation of this research is the need to reduce medication conflict and optimize medication regimens for individuals with DCCs. To achieve this, we allowed patients to specify their health conditions and primary and major treatment concerns, for example, costs of medication, interactions with current drugs, and weight gain. Utilizing data gathered from MTurk and Qualtrics, we gained insights into healthcare providers’ strategies for making/customizing medication regimens. We constructed a dataset and subsequently deployed machine learning algorithms to predict optimal medication regimens for DCC patients with specific treatment concerns. Following the benchmarking different models, Random forest emerged as the top performer, achieving an accuracy of 0.93. This research contributes significantly to the enhancement of decision-making processes, empowers patients to take a more active role in their healthcare, and promotes more informed and productive discussions between patients and their care teams.

Prevalence and determinants of multimorbidity in the Canadian population.

Multimorbidity, which is defined as having at least two or more chronic diseases concurrently, has been a rising public health issue in recent years in Canada and worldwide. The increasing prevalence of multimorbidity has posed a burden on the current health care system and quality of life for the Canadian population. There is a lack of up-to-date research on determinants of multimorbidity in the Canadian population, which is necessary to better understand and prevent multimorbidity. This study aims to determine the prevalence and risk factors of multimorbidity in the middle-aged and older Canadian adult population. Multivariable logistic regression analyses incorporating survey weights and biologically plausible interactions were conducted to examine the determinants of multimorbidity using data from the 2017/2018 Canadian Community Health Survey (CCHS). Of the 113,290 CCHS participants, 82,508 subjects who were aged 35 years and above were included in the study. The prevalence of multimorbidity was 22.20% (95% CI: 21.74%, 22.67%) and was greater for females. Multimorbidity was more likely in subjects who were obese, abstaining from alcohol, inactive, had a lower education level, widowed, divorced, or separated and was less likely among subjects living in Quebec. The protective effect of household income on multimorbidity decreased with age. Current smokers who reported extreme stress were more likely to have multimorbidity. Multimorbidity is associated with various determinants that need to be considered in chronic disease control and prevention. These results suggest that future research should focus not only on these determinants but also on the relationships between them. A future longitudinal study is required to provide causal evidence for the study findings.

The emergence of telemedicine in a low-middle-income country: challenges and opportunities.

The quality of cancer care delivery varies across different regions of Ghana, highlighting the need for improved access to quality healthcare services. Telemedicine has emerged as a promising solution to address this disparity, as it can reduce costs and improve access to healthcare services for cancer patients in remote areas. Despite the widely reported benefits of telemedicine, its adoption in low-resource settings has been slow due to several challenges. This study explores strategies for incorporating telemedicine into the current healthcare system in Ghana for the benefit of all patients especially those diagnosed with cancer. The study also highlights the current challenges and opportunities associated with the implementation and utilisation of telemedicine in Ghana. This research was a cross-sectional study conducted in Accra, Ghana that adopted a mixed-methods approach. Participants were selected through multi-stage probability sampling. Quantitative data were collected via a survey whereas qualitative data were obtained by means of in-depth interviews and focus group discussions among healthcare professionals, patients and key stakeholders in the telemedicine industry. The Statistical Program for the Social Sciences (version 21) was used to assemble, analyse and display the research data. The major challenges discussed centered on high initial investment costs, privacy and security concerns, poor internet connectivity, insufficient infrastructure and training of healthcare providers as well as the resistance to change among healthcare professionals. The study contributes to the understanding of telemedicine adoption in Ghana with findings underscoring the potential to address healthcare challenges while highlighting the need to overcome implementation obstacles. The study findings also provide valuable insights for policymakers, healthcare institutions and stakeholders to enhance telemedicine adoption in Ghana.

The imperative for cross-cultural medical education in globalized healthcare.

Current healthcare systems are like living creatures. They are highly complex, multi-faceted, and dynamic. They must constantly change and adapt; they are like a melting pot, brimming with both rich and diverse cultures from all corners of the world. Beyond just nationality, these systems can include many languages, religious beliefs, socioeconomic backgrounds, and unique health practices. The tides of globalization, multicultural societies, migration, and international collaboration are continuously reshaping how healthcare providers are educated and how healthcare is delivered in an equitable, inclusive, and fair manner. To keep pace with, and within, these highly vibrant socio-cultural frameworks, Cross-Cultural Medical Education is needed to educate healthcare professionals. This education is essential to create professionals who are not just skilled, but who are also culturally savvy and able provide fair and equal care to patients from all sorts of backgrounds. It provides professionals with foundational knowledge to navigate the complex landscape of diverse patient populations. Cross-Cultural Medical Education is thus of paramount importance to satisfy the need for effective cross-cultural communication and understanding in patient care preferences, ultimately leading to improved health outcomes.